TCTAP C-235 An Old Man Needed 3 Stent Grafts to Fix Critical Aortic Stenosis and Transsubclavian Vascular Access Complication

[Clinical Information] Patient initials or identifier number 9389758 Relevant clinical history and physical exam 83 years old man A case of symptomatic severe aortic stenosis with high surgical risk (Logistic EuroScore 23%) Co-morbidities: COPD, BPH, Chyluria Relevant test results prior to catheterization Transthoracic Echocardiography Preserved LV & RV systolic function Severely calcified & degenerated trileaflet aortic valve Critical aortic stenosis ~ 0.6cm2 by continuity equation Aortic valve pressure gradient (peak ~ 87mmHg, mean ~ 56mmHg) Moderate aortic regurgitation Moderate mitral regurgitation Moderate tricuspid regurgitation (RVSP ~ 52mmHg) CT angiography aortic annulus diameter 18.5x26.6mm, Severe disease of bilateral iliac arteries [Interventional Management] Procedural step Procedure: Transcatheter aortic valve implantation Approach: Left subclavian artery (cut down) Anesthesia: General Devices: Ultimum introducer sheath 18F 30cm (St. Jude Medical) Amplatz super stiff straight guidewire 0.035" 260cm (Boston scientific) 3rd generation CoreValve 29mm (Medtronic) Temporary pacemaker implantation in RV was done via right subclavian vein. 5F pigtail catheter was placed in non-coronary sinus via right brachial artery for supra-aortic angiogram.